http://orcid.org/0000-0002-8367-1189
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Abstract
Objectives: The study aimed to investigate the effect on survival after 6 months of treatment involving individual dietary advice and oral nutritional supplements in older malnourished adults after discharge from hospital.
Methods: This multicentre randomised controlled trial included 671 patients aged 65 years who were malnourished or at risk of malnutrition when admitted to hospital between 2010 and 2014, and followed up after 8.2 years (median 4.1 years). Patients were randomised to receive dietary advice or oral nutritional supplements, separate or in combination, or routine care. The intervention started at discharge from the hospital and continued for 6 months, with survival being the main outcome measure.
Results: During the follow-up period 398 (59.3%) participants died. At follow-up, the survival rates were 36.9% for dietary advice, 42.4% for oral nutritional supplements, 40.2% for dietary advice combined with oral nutritional supplements, and 43.3% for the control group (log-rank test p = 0.762). After stratifying the participants according to nutritional status, survival still did not differ significantly between the treatment arms (log-rank test p = 0.480 and p = 0.298 for the 506 participants at risk of malnutrition and the 165 malnourished participants, respectively).
Conclusions: Oral nutritional supplements with or without dietary advice, or dietary advice alone, do not improve the survival of malnourished older adults. These results do not support the routine use of supplements in older malnourished adults, provided that survival is the aim of the treatment.
Trial registration: ClinicalTrials.gov with ID: NCT01057914
Acknowledgements
The authors thank the dietitians who recruited the patients for the study and performed the nutritional treatments.
Disclosure statement
No potential conflict of interest was reported by the author(s).
Additional information
Funding
Notes on contributors
Lisa Söderström
Lisa Söderström is a dietitian and obtained her PhD in Medical Sciences in 2016 at Uppsala University. Previously a lecturer in nutrition at Uppsala University, she is currently working at the Centre for Clinical Research in Västerås, Sweden.
Andreas Rosenblad
Andreas Rosenblad, previously Karlsson, born 1973, obtained his PhD in Statistics from Uppsala University in 2006, and has been Associate Professor in Applied Medical Statistics and Epidemiology at Uppsala University since 2014. Previously a senior lecturer in Statistics at Stockholm University, he is currently an affiliated researcher at the Department of Medical Sciences, Uppsala University, and employed as a statistician at the Regional Cancer Centre Stockholm-Gotland.
Leif Bergkvist
Leif Bergkvist, MD, PhD, received his PhD in 1987 at Uppsala University, Associate Professor 1996, and Professor of Breast Surgery 2007. He was Head of the Breast Unit in Västerås over 20 years, and working part time at the Centre for Clinical Research from 1999 to retirement, but is still affiliated. Main interest is clinical research in breast cancer, epidemiology, and nutrition.
Hanna Frid
Hanna Frid is a dietitian at the Department of Child and Adolescence Psychiatry, Västmanland County Hospital Västerås, Sweden.
Eva Thors Adolfsson
Eva Thors Adolfsson is a dietitian and obtained her PhD in Medical Sciences in 2008 at Uppsala University. She became Associate Professor in Care Science at Uppsala University 2017. She has worked as a developer in Region Västmanland from 2009 to 2019 and since 2019 as a part-time researcher at the Centre for Clinical Research in Västerås, Sweden.